Gordon Brown’s belated admission of looming spending cuts unleashed a masochistic torrent of bid and counter-bid by leading politicians.
Some of it is silly. Here in Bournemouth the Liberal Democrat conference has not been immune.
By the time my train pulled into the station at midday on Sunday Nick Clegg had invoked the need for “bold, if not savage cuts” ahead. And Norman Lamb, his health spokesman, had already made a speech promising to slay the “bureaucratic monster” of health quangos which now employ 25,000 people and cost an estimated £1.2bn a year.
Yeah right, I hear you murmur: the Lib Dems are unlikely to be required to do any of this
What did he mean? Well, he wants to scrap strategic health authorities for one thing - “they have no place in a decentralised NHS” - to save £500m centrally and free up hospitals to do their own thing. Local decision making will be central to health speeches at all the party conferences this season.
Norfolk Lamb (my nickname) also wants to cull regulators who ask duplicatory questions - you know a few of them - but so did his rivals last time I looked. But his speech was not all cuts: he wants to deliver on Labour’s pledge to give mothers the same midwife throughout their term by recruiting 3,000 more.
His party leader may be made of sterner stuff, although he did admit to paying cash for private treatment for one of his kids when his patience with the NHS ran out (no harm in that, surely?). His “Better Politics for Less” programme includes freezing ministers’ salaries, cutting their numbers from around 120 to 73 and cutting Whitehall departments from 20 or so to 14.
Public sector pension subsidies and pay are also targets. Clegg calls it “progressive austerity” and stresses fairness, rightly so, but there are never enough rich to pay it all.
Yeah right, I hear you murmur: the Lib Dems are unlikely to be required to do any of this, although Clegg believes the time is right to reverse the historic verdict of the 1920s when Labour ousted Liberalism as the main rival to the Tories. Just as the Libs then failed to grasp the role of the modern state so Labour today fails to let go the centre’s grip and recognise the new individualism, he argues.
In a new pamphlet, The Liberal Moment, he applies such talk to the NHS, praising Labour’s huge spending increases while saying that its centralised model has not delivered the results that extra cash deserves. He also notes that health inequalities have risen since 1997.
True, but surely because Labour has been trying to run up a down escalator?
Clegg says his decentralised “patient contract” would guarantee entitlements (“including mental health concerns”) and waits - or pay the private sector when they fail.
Hmm. I smell money burning there too.
His speech reminded me of the old poem, Casabianca, which famously began: “The boy stood on the burning deck, whence all but he had fled…” No glass half empty thinking, no slipping back from hard-won progress since 2000, Boy Burnham declared.
Primary care trust budgets are still rising (by 5.5 per cent this year and next), but the NHS must learn to perform better in what that old Whitehall warrior, Professor Paul Corrigan, calls “at very best a standstill in resources”.
That is the maddening thing about health economics. Unlike other trades, in a recession demand goes up, not down. Damn!